doctor please, some more of these

To gild the lily, the pharmaceutical industry touted the SSRIs as non-habit-forming. "Paxil is not a controlled substance," explains GlaxoSmithKline's promotional literature. "Paxil belongs to a class of medications called SSRIs, which have not been shown to be associated with addiction." The claim is repeated in all of the ads for Paxil, and in the drug information GlaxoSmithKline gives to doctors.

Kevin Murphy found all of this information comforting when he and his wife struggled with the decision to put their 11-year-old daughter Kelly on medication. She'd been having panic attacks for a while and had tried several kinds of therapy. Nothing worked, so the Murphys, who live in Lino Lakes, swallowed their concerns and took Kelly to see a psychiatrist. "He prescribed a couple of medications that didn't do anything," Kevin Murphy recalls. "He switched her over to Paxil, and Paxil worked pretty quickly.

"We had talked to the doctor and said what we'd really like to do is have her on it for a year and then take her off of it in the hope that her body would have unlearned the panic response," he continues. "As we drew near the end of that year, her doctor said very casually that it's always a good idea to taper off of this very gradually. She was already cracking a 10-milligram tablet in half, then she started cracking that in half, too, to get to 2.5 milligrams.

Diana Watters

"Finally, she was off of it altogether for a couple of days and then she started to have panic attacks. Her heart would just race, and then she'd think she was going to be sick--and she hates being sick. So we called the doctor, and he said to put her back on it."

For the next three-plus years, they tried other tactics for weaning her off the drug. They tried switching her to Celexa, another SSRI. That failed. They tried the same tactic, but using Prozac. They tried anti-nausea drugs, acupuncture--"everything," Murphy says, "but nothing helped."

In addition to excruciating stomach pain, Kelly was so nauseated she couldn't sleep or eat. Doctors examined her upper gastrointestinal system. She had a CT scan, an ultrasound, and countless other tests. Each showed her to be healthy. And yet each time she stopped taking Paxil, she found herself homebound. And each time, she went back on Paxil--at a higher dosage.

Kelly's mother, Maureen Murphy, was forced to quit her job to stay home with her. She missed months of school. "We had to get a tutor for her so she wouldn't fail school," Kevin Murphy says. "She lost 10 pounds. She would be up until 1:00, 2:00, 3:00 a.m. trying to sleep.

"And all the while her psychiatrist said, 'This is really weird. I'll check with the drug company and see what's going on.' And they told him that nothing like this happens with this drug," he recalls. As for Kelly, he adds, "She told me several times she wished she were dead."

Right now she's trying one more time to taper off Paxil. On the advice of a psychiatrist, she switched to a liquid form of the drug so she could decrease her dose by one milligram each month.

Last fall, Murphy became one of 34 named plaintiffs in a class-action lawsuit filed in U.S. District Court in Los Angeles. Since then, some 6,000 people have joined the suit. Several other law firms are pursuing similar suits in the United States. In addition, suits have been filed in Canada (in British Columbia, Ontario, and Quebec) and in England.

In 1992, when Paxil hit the market, it faced a seemingly uphill battle to wrest customers from older SSRIs such as Prozac and Zoloft. The U.S. Food and Drug Administration had approved Paxil for the treatment of depression, like those drugs. But its manufacturer, SmithKline Beecham (because of a 2001 merger, now GlaxoSmithKline), was more interested in positioning Paxil as a remedy for anxiety disorders.

Before SSRIs, anxiety had been treated mostly with psychotherapy. In the most serious cases, psychiatrists turned to Valium and other benzodiazepines--again, drugs with a host of serious side effects. Just as Prozac had revolutionized the treatment of depression, SmithKline promised to change the treatment of anxiety disorders by providing a safe alternative.

The company quickly secured permission to market Paxil for the treatment of panic disorder and obsessive-compulsive disorder. By mid-1995, Paxil had become the fastest-growing SSRI in the United States. In 1996, sales of the drug had climbed 54 percent to $291 million.

Impressive though those numbers may be, SmithKline was on the verge of a much bigger marketing coup: The company had been working to win approval from the U.S. Food and Drug Administration to market Paxil as a treatment for the first of a series of little-known mental health ills. In 1999, the FDA agreed to allow Paxil's prescription for the previously rare "social anxiety disorder."

SmithKline hired a New York public relations firm to raise awareness about the syndrome. According to the trade journal PR News, Cohn & Wolfe "developed a plan to educate reporters, consumers, and, in some cases, physicians, in an effort to encourage diagnosis and treatment."